John Q. in Canada

June 2002 -- Author's note: Ed Hudgins' insightful exposé of the movie John Q., in the April 2002 Navigator , provided a clear and concise presentation of the issues. The position of the Left was summed up with special exactitude in the statement:"John Q. also gives us the essence of the Left in its message that health care is a 'right.' To be paid for by whom?

The government, of course."As I live in British Columbia, Canada, it occurred to me to ask: What would have been the outcome for John Q.'s son in Canada, where everyone is presumed to have a "right" to health care and the Canadian national health-care service purports to offer what John Q. demanded, "Free health care for everyone!" For background, I begin by briefly describing how Canadian national health care works.— J.V.

With passage of the Canadian Medical Care Act (1968), the Canadian government instituted national health care, whereby the government pays for nearly all health-care services for its citizens. With "free health care for everyone," there are essentially no restrictions imposed upon the Canadian citizen's demand for health-care services. Not surprisingly, demand for these services is approximately 25 percent higher in Canada than in the United States. In order to regulate this increase in demand, as well as rising health-care costs in general, the Canadian government rations all health-care services, such as the number of doctors, hospitals, and surgical procedures, through regional allocations. This notion of rationing health-care services is quite foreign to those in the United States, where health-care costs are predominately regulated by supply and demand within the free market, notwithstanding some of the U.S. government's efforts to the contrary.

With health-care services in Canada being rationed, demand for those services generally exceeds supply. To mediate this problem, patients are placed on waiting lists to see specialists and for surgical procedures. For example, as of March 31, 2002, the total number of people waiting for surgical procedures in B.C. was 65,446 ( Surgical Wait List Registry, Government of British Columbia , ). Wait times vary depending upon the surgical procedure—as well as doctor and surgical-suite availability—from an average of forty-eight months for a kidney transplant to an average of three months for a heart transplant ( British Columbia Transplant Society ).

Now let's consider what John Q. would have faced here in Canada under national health care. After his son collapsed at the baseball game, the boy would have been taken to the nearest hospital emergency room for treatment. The attendant emergency room physician would have discovered that he had an enlarged heart. A specialist would have been called in to confirm the diagnosis, and most likely a heart transplant would have been recommended. So far, essentially everything would have proceeded here in Canada, under national health care, as in the United States according to the movie.

But following the medical assessment, it would then be necessary to determine the son's priority for the transplant surgery. Fortunately for John Q., his son is both young and hopefully considered an emergency case. Both of these factors would gain him favor in determining his priority on the waiting list. This might seem similar to health care in the United States. But the important difference to note is that when the surgery will be performed is not based on John Q.'s desire and ability to obtain the health-care services he deems necessary. Rather, it is the government, acting through restrictions on doctors and hospitals under a rationed health-care system, that determines when the surgery will be performed.

So, when John Q. realizes that his son might die while on the waiting list for the heart transplant, he might decide to take matters into his own hands. He might, as in the movie, attempt to appeal to the hospital administrator. But this would be to no avail in Canada, as the hospital administrator is powerless to provide any health-care services that have not been previously authorized. In this case the administrator would not even need to be arrogant or unfeeling, as the government has removed all blame from her for refusing services, in the name of serving the common good.

Next, one might expect that John Q. would attempt to raise the funds to pay for the surgery himself, either by his own means or by appealing to family, friends, or some charity. But even if he were successful in raising the funds, it would again be to no purpose. In Canada, under national health care, it is illegal to "jump the waiting list" and have any surgical procedure performed sooner, even if one has the means to pay for it. Most U.S. citizens are not aware of this restriction. It is, in my mind, the most immoral aspect of nationalized health care. Individuals are literally prevented from receiving the health care they deem necessary, even if they have the means and are willing to pay for it themselves.

In the end, then, John Q. would be presented with the same situation concerning his son's heart transplant. The difference would be that, in Canada, his son might die not because John Q. couldn't afford to pay for the transplant but because the government couldn't afford to pay for the transplant. Moreover, since he would be prevented from providing his son with a heart transplant in time even if he could find funds to pay for it, he might be even more inclined to resort to terrorism.

Fortunately, at present, John Q. in Canada would still have one option left. Assuming he could raise the funds for the heart transplant, he could take his son to the United States for the procedure. The U.S. health-care system is considered the refuge of last hope for many Canadian citizens facing similar circumstances. John Q. would not be compensated for any of these costs in the United States by the Canadian medical system, even though he had paid, through taxation, into the system for his entire life. Such is the double indemnity extracted by Canadian national health care for "jumping the waiting list." But he would, of course, be compensated by the knowledge that he had provided his son with the health care he deemed necessary. To which I say in closing, "God bless the U.S. health-care system." May it remain free and unregulated forever! My life may one day depend upon it.

John Vincent, a retired computer software entrepreneur living near Victoria, British Columbia, has been a student of Objectivism for twenty-five years. Currently, he pursues a wide range of intellectual interests, including philosophy, architecture, and astronomy, as well as activities such as traveling, sailing, and woodworking.

This article originally appeared in the June 2002 issue of Navigator magazine, The Atlas Society precursor to The New Individualist.

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